Individual
MR. ROBERT ERNEST LIEBAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
VATL, ATC
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 403-2913
Mailing address
10705 HEATHER GREENS CIRCLE, SPOTSYLVANIA, VA 22553
(540) 891-4607
(540) 654-1717
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000238
VA
Other
Enumeration date
05/01/2007
Last updated
04/16/2016
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